HomeMy Public PortalAbout10620 DAINES DR_Sewer__ p
IsAE.663 12.54 APPLICATION.- FOR PERMIT
. 5 4 E.6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
'Department of County Engineer
s` County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS q� MNO.
.
CASSATT O. GRIFFIN, SVP'T oP BuiLo1NG LOCALITY / GxFOR APPLICANT TO FILL INNEARESTCROSS ST,DESELRIPTION LOT NO. �Z+ / ' �/1 OWNERBLOCK TRACT 9 MAIL
ADDRESSSIZE OF LOT TS a CITY
USE OF J
BUILDINGS Z DISTRICT NO. l GROUP MAP FG
CONTRACTOR a Q J' `K ''��
ADDRESS 2 !� CONNECTION DATA
CITY 60 TEL. N0. 112T STATION DEPTH /n
��//// STATE MA {HOLE REFERENCE
REGISTRATION NO. /� � COUNTY • PER
TYPE O'CONNECT .L. LENGTH FM
No. DESCRIPTION OF WORK FEE Y. CURB M.L. TD P.L.RO
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q S 3.50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 T
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0.
VI /33�j ONN C HOUSE
SEWER 1.00 / JOB. NO.f
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1,00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR ,
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYYJELL -- WASTE APPR AL
SPECIAL CONDITIONS ONLY 2.00 ES
-- CONNECTION CHARGE FE
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FEE r" 1 REIMBURSEMENT F.
I HAVE -THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APP OVALS DATE INSPECTOR'S SIGNATURE
TO THEPUBLIC S W R
SIGNED THIS -DAY OF �- 79 _py NEW HOUSE SEWER �/•/� L�I�����
OWNER - OR N60NNECT ADDITIONAL F
OWNERS AGENT• BUILDING OR WORK
ADDRESS 1AO SEPTIC TANK. SEEP, PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL D DRYWELL D
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS 'REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REG -FRED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COU Y AND STATE OF
CALIFORNIA OR THAT. I AM THE LEG OW R OF THE A3011 ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL P PERTY: BACKFILL SEPTIC TANKS D
SEEP. PIT(S) D CESSPOOLS
SI OFPERMETTE L 41'GNATUR
� ( •¢/ J �
WILLIAM J. FOX. COUN ENGINEER ATIIOON'''`) y'
:By
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BY
.. DEPUTY DEPUTY
BY BY
.'® DEPUTY. DEPUTY